# Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients with Non-ST-Segment Elevation Myocardial Infarction in the United States: Results from Big Data Analysis

## TL;DR

This study compares intravascular imaging-guided and angiography-guided procedures for heart attacks in the U.S., finding similar mortality rates but other benefits and costs.

## Contribution

The study provides updated real-world evidence on the outcomes of ICI-guided PCI versus angiography-guided PCI for NSTEMI patients in the U.S.

## Key findings

- ICI use tripled between 2016 and 2021 with no significant difference in in-hospital mortality.
- ICI was linked to lower odds of cardiogenic shock and cardiac arrest but longer hospital stays and costs.
- Mortality rates for both methods were similar and relatively low.

## Abstract

Non-ST-segment elevation myocardial infarction (NSTEMI) can be managed by ischemia guide strategies or early invasive strategies. Here, we present the findings of an updated contemporary analysis regarding the use of intracoronary imaging (ICI)-guided PCI versus angiography-guided PCI and in-hospital mortality in patients with NSTEMI in the United States using the NIS database from 2016 to 2021. ICI use increased by nearly threefold between 2016 and 2021, without a significant difference in in-hospital mortality, though interestingly, mortality rates compared with angiography guidance were similar and relatively low. In this study, the use of ICI was associated with lower adjusted odds of in-hospital mortality, cardiogenic shock, and cardiac arrest, but with a longer length of stay and cost of hospitalization.